Re: the mystery of the lacking German deaths
And here some more recent data:
http://www.aerzteblatt.de/v4/archiv/artikel.asp?id=65650
Google translation
New Influenza Working Group
New Influenza: Current Situation and Strategy
MEDICAL REPORT
responsible: Dr. Andreas Gilsdorf
(GilsdorfA@rki.de), Marleen Dettmann
PD Dr. Gabriele Poggensee, Dr. Walter Haas
Reduce and slow the spread was initially the target
the strategy against the new flu. With significantly rising numbers of cases but now is the protection of vulnerable groups in the foreground.
The number of cases of the new influenza A/H1N1 has grown significantly over the last few weeks in Germany as in other European countries (see graph).
Until 6 August 2009 are here 9 213 cases have been reported. The reports are made according Meldeverordnung of 30 April by the doctors to the health authorities and in accordance with ? 7 paragraph 1 Infection Protection Act also through the labs. In the following cases are described that up to 29 July, health authorities and reported electronically to the Robert Koch Institute (RKI) was provided (N = 5 324).
Onset of the first case was 20 April. This is a person who had traveled to Mexico and even there became ill. By the end of May there were only a few cases, mostly associated with travel, but also partly secondary infections, which were due to travel returnees. In June, the number of new cases is about ten to 50 per day, the daily number of notified cases, however, increased significantly since mid-July.
Average age of sufferers is 23 years
54 percent of sufferers are male. The average age is 22.8 years (range: 0 to 89 years). Most patients (77 percent) are ten to 29 years old. Four percent of the cases are younger than ten years, 18 percent are 30 to 59 years old, less than one percent of reported cases are 60 years and older.
From 5 291 (99 percent) cases, which were listed in which a likely country of infection, 22 percent had acquired the infection in Germany. In the first weeks of the pandemic was mentioned reiseassoziierten diseases especially North America as its main objective.
Since early July, the proportion of infections acquired in other European countries, much bigger. During this period, was indicated in 84 percent of infections reiseassoziierten Spain as a travel destination, followed by Britain (five percent) and North America and Bulgaria each (two percent). The high proportion of cases imported from Spain, but speaks for a relevant infectious events in Spain, but also reflects the travel behavior of Germans, according to the Federal Statistics Office flew June to August 2008 approximately 1.1 million people every month from Germany to Spain, in addition, There are also many bus passengers.
In Meldewochen 27 to 30 an increase in the incidence (cases per 100 000 inhabitants) is seen, which began in the northern and western provinces, and continuing through the last weeks in east and south. This can also by travelers, notably the different holidays began to be conditioned in the provinces.
Interestingly,
the proportion of persons who are hospitalized because of illness: The information on the one hand, hospitalization may indicate the severity of the disease, on the other hand it also reflects an impression of the additional burden to hospitals by the New influenza.
A limiting must be assumed that a proportion of cases for differential diagnosis diagnosis and isolation measures was hospitalized. This would mainly apply to cases that were hospitalized in the first weeks after the onset of the disease in Germany.
In all, 578 individuals (eleven percent) reported to be hospitalised.
In the calendar weeks 29 to 31 of hospitalization was 8.5 to 10.5 percent. The average age of the patients hospitalized during these weeks was 22 years, and corresponded to that of not hospitalised.
Risk factors such as respiratory, cardiovascular disease, diabetes or pregnancy have a strong influence on the disease process. With 2 212 cases (42 percent), there was information on risk factors. Risks were available in 77 cases (3.5 percent). Here the focus was on chronic respiratory diseases, followed by cardiovascular disease, diabetes and pregnancy. Of these, 77 people were hospitalized 22 (29 percent). The share is in this group, almost three-fold increase compared to all cases.
The progress of cases in Germany in the early stages of the pandemic, speaks for the effectiveness of the strategy pursued initially on halting and slowing the spread through the early detection of cases and the interruption of the infection chain by means of strict infection protection measures in patients and contacts.
Adaptation of the strategy with an increasing number of cases
With the significant increase in particular cases reiseassoziierten end of June this approach meant an increasing burden on the resources of the public health. Based on a better understanding of the new pathogen, the clinical course and the most vulnerable groups were, therefore, after extensive discussions between the Federation and countries, a strategy adjustment. The objective now is to have the known risk groups, the higher risk for complications from infections with the new influenza, protected from possible infection.
The Arztmeldepflicht is a major component. It is particularly important that the doctors at the medical history, even after the possible contacts of patients with high-risk groups to ask and report them to the health department. To describe the most vulnerable groups in Germany to be, was established in the surveillance, a systematic survey of risk factors, the first based on the above figures for Germany.
The strategy for the prevention of infections in the general population is primarily due to active information to avoid risks of transmission and basic hygiene measures.
Latest figures from the Sentinel of the Association of influenza is currently also show that the majority of acute respiratory disease currently occurring continue is not caused by influenza (Positivenrate in 29 to 31 Meldewoche = eight to 15 percent). Among the positive samples, there were almost exclusively of new influenza cases, but also occasionally to infection with seasonal circulating influenza viruses.
Since among patients with acute respiratory disease, the rate is still low, with A/H1N1-Infizierten therefore, should normally be made only after a therapeutic intervention laboratory diagnostic confirmation.
In the seasons 2007/08 and 2008/09, almost 100 percent of the circulating seasonal Influenza-A/H1-Viren were resistant to the neuraminidase inhibitor oseltamivir. With the new influenza have been detected in Germany so far no resistance, worldwide there have so far been isolated. The risk of resistance development in the new influenza, however, increases with an untargeted use and the proportion of self-medication. In the treatment of persons associated with an increased risk for a severe course in the center of policy adjustment. In their early treatment should be started, possibly even prior to the laboratory diagnostic confirmation.
Job-related medical personnel is one of the group of persons is both at an increased risk of becoming infected than the same time has contact with vulnerable groups. Therefore, the exposure protection is especially important, and these are the recommendations of the occupational already observed consistently in all cases of acute respiratory illness. This serves not only to protect themselves and family members, but in particular the protection of patients receiving care.
To proceed in the future quickly and successfully to prevent the spread and impact of the pandemic, which is explicitly dependent on the public health service doctors that supply in primary care patients. Here are mainly in the diagnosis, early treatment of vulnerable groups and the message in the foreground.
New influenza working group,
Division of Infectious Disease Epidemiology,
Robert Koch Institute, Berlin
VULNERABLE GROUPS
When infected by new influenza following persons are at risk,
To develop complications:
- Pregnant
- Children, adolescents and adults with increased health risks due to an underlying disease, such as:
- Chronic respiratory disease (including asthma and COPD)
- Chronic cardiovascular, liver and kidney diseases
- Diabetes and other metabolic diseases
- Multiple sclerosis with relapses triggered by infection
- Congenital or acquired immunodeficiencies
- Severe obesity